June 2019

Rendering Provider Fee Schedule Reminder

Reimbursement is based on the type of rendering provider indicated on the claim. The provider types listed below will have the differentials applied to the Schedule of Maximum Allowances (SMA) as noted:

100% of the SMA

• Physician

85% of the SMA

• Licensed Clinical Psychologist
• Certified Nurse Specialist
• Certified Nurse Practitioner
• Certified Registered Nurse Anesthetist
• Certified Nurse Midwife
• Licensed Physician Assistant

85% of 20% of the SMA

• Licensed Surgical Assistant
• Registered Nurse First Assistants

70% of the SMA

• Licensed Clinical Social Worker
• Master Social Worker
• Licensed Clinical Professional Counselor
• Licensed Professional Counselor
• Licensed Marriage and Family Therapist
• Board Certified Behavioral Analyst
• Board Certified Assistant Behavioral Analyst
• Certified Early Intervention Specialist
• Developmental Therapist